Primary Care Coding Alert

Question: When destroying multiple lesions using cryosurgery, my doctors want to bill just 17003, but I thought I couldn't bill that code without reporting 17000. Am I correct? Also, when the patient comes back a few days later because the lesion returned, the docs don't bill at all because they say it's part of the global period. I say they should charge again. Who's right? Minnesota Subscriber Answer: When billing for the destruction of multiple lesions, CPT says, you should use 17000* (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion) for the first lesion and +17003 ( second through 14 lesions, each [list separately in addition to code for first lesion]) for each additional lesion 2 through 14. For example, if the physician destroyed 10 lesions by cryosurgery, he or she should bill 17000 and 17003 x 9. The 2002 Medicare Physician Fee Schedule Database indicates that 17000 and 17003 have a 10-day postoperative global period. Any service provided during that period that directly relates to the specific lesions removed at the first visit should not be billed separately.

However, if the physician removes other lesions during the 10-day post-op period, he or she may bill for them separately by attaching modifier -79 (Unrelated procedure or service by the same physician during the postoperative period). Check with your payers to find out if they have a different global surgery period. Answered by Susan O. Minchew, CPC, CHC, director of billing compliance for Emory Healthcare in Atlanta.